Ah caffeine, my drug of choice

I started drinking coffee far too early. I blame it for my short stature (nothing to do with my 4’11” grandmother).
And more so than alcohol, the one thing I knew I would miss in these months ahead would be that morning (and sometimes afternoon) cup of coffee.

But do I have to ditch my daily dose of caffeine because I am growing a little human?

The general reviews and advice seem mixed – varying widely from “Oh god no!!!!!” to “hmmm… it’s not so bad”. Yeah, kind of a big range.

The websites attempting to answer this question rationally seem to suggest negative consequences but settle on the jury-is-still-out, limit-your-intake-just-in-case approach.

I decided to look a bit closer at some of the science covering the main concerns on those “Oh, god, no!” sites. Since this post is a bit lengthy, I bolded the categories so that you can fast-forward to the bits you are actually interested in.

Miscarriage
A lot of the pregnancy websites offer the strongest evidence for and against caffeine based on two opposing scientific papers that specifically address risk of miscarriage.

First, a 2008 paper by Weng and colleagues published in American Journal of Obstetrics and Gynecology found an association between caffeine consumption and rate of miscarriage. But an article published in Epidemiology by Savitz and colleagues, also in 2008, found that caffeine consumption had no effect on increased risk of miscarriage.

So, what gives? Why such drastically different results. Ah, tis the nature of science, I suppose – so many variables can differ! One potential difference stood out to me – the amount of caffeine that is actually in the “high caffeine intake” group.

How to determine caffeine consumption –
Weng and colleagues (caffeine=BAD) asked the women to recall their overall caffeine consumption since becoming pregnant – essentially “how much caffeine have you had since your last menstrual period?”
Savitz and colleagues (caffeine=OK) asked women to recall how much they consumed before getting pregnant, since becoming pregnant, and at that very moment of the interview.Can you recall every cup of coffee you have had since getting pregnant?

Pregnant lady population-
Weng et al. included women who came into the hospital to confirm a pregnancy and continue on from there.
Savitz et al. study included women who started visiting a clinic for prenatal care and were planning for pregnancy.Could the women in Savitz’s study already be limiting their caffeine intake in anticipation of becoming pregnant?

Caffeine consumption classification-
Weng et al. blocked the women into 3 groups: no caffeine, low caffeine (<200 mg/day -pretty much a small cup of coffee a day), and high caffeine (>200 mg/day of caffeine – if you order a tall at Starbucks on a daily basis, this includes you!).
Savitz et al. also classified total caffeine consumption but assigned the “groups” according to the median of overall caffeine consumption for each time point. This actually ended up working out to about <200 mg/day and >200 mg/day for the during-pregancy point.

Hmmm… still pretty similar (although there are a dozen + other small differences between the women included in each study)

One thing that Savitz et al. points out about the limitations of their study is that the women included (remember, these are women that have been actively seeking prenatal care) did not show a high range of caffeine intake (>300-400 mg/day). And this high exposure range is the range that has been suggested to increase risk of miscarriage (discussed in a review by Signorello et al. in Epidemiology in 2004).

So, could the difference simply be that the “high caffeine” group in the Weng et al. study included women who were exposed to higher doses of caffeine than their counterparts in the Savitz et al. study?
(Unfortunately, I couldn’t find this sort of data point in the Weng et al. paper).

Ok, so the advice on this one seems to be – caffeine might be ok… in moderation.

What about other aspects? Growth? Development? Behavioral problems? Cancer?

Growth and development
A 2009 paper by Jahanfar and Jaafar, published in Obstetrics and Gynecology, looked at the outcome of decreasing the amount of caffeine pregnant women drank in the 2nd and 3rd trimester. In this paper, the authors describe a study conducted with a cohort of women who drank A LOT of caffeine (3 cups a day!). Half of these women were tricked into decreasing their intake via decaf coffee while letting the other half continue on feeding their caffeine addiction. Comparing the babies at the end? No effect on birth weight, no effect on length of gestation.

This outcome was also suggested by Jarosz and colleagues in a 2012 paper in the European Journal of Obstetrics & Gynecology and Reproductive Biology who found no association between caffeine and birth weight or risk of premature birth. All women considered in this study consumed less than 300 mg/day.

So contrary to some of the warnings about caffeine – at least from these two studies – it appears that caffeine hooked mama’s don’t birth smaller babies earlier.

Behavior problems later
A 2012 study by Loomans et al. published in Pediatrics found absolutely no evidence for increased risk of behavioral problems in children (5-6 years old) born to mothers who hit the coffee pot.

Cancer
A 2013 in Cancer Causes Control paper by Bonaventure et al. found increasing risk of childhood acute leukemia with the mother’s caffeine consumption. This risk increase was most evident when comparing mother’s who drank two cups of coffee versus none. Uh oh.

But something to consider – there is a 0.04% chance your child will be diagnosed with acute leukemia and two cups of coffee raises this risk to 0.06%.

Ok, ok, my PhD still doesn’t give me any authority to dispense medical advice to myself or to any of you pregnant readers out there.

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Now to deal with the bitter looks one gets when ordering a full-caf cup of coffe with a big pregnant belly! Time to bust out those big billowy dresses or wear a sandwich board with this blog in bold on the front